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Meta-Analysis
. 2023 Oct;55(10):2545-2556.
doi: 10.1007/s11255-023-03568-3. Epub 2023 Mar 30.

Reno-protective effects of perioperative dexmedetomidine in kidney transplantation: a systematic review and meta-analysis of randomized controlled trials

Mohamed T Abuelazm  1 , Ahmed Ghanem  2 , Amit Johanis  3 , Abdelrahman Mahmoud  4 , Abdul Rhman Hassan  5 , Basant E Katamesh  1 , Mostafa Atef Amin  6 , Basel Abdelazeem  7   8
Affiliations
Meta-Analysis

Reno-protective effects of perioperative dexmedetomidine in kidney transplantation: a systematic review and meta-analysis of randomized controlled trials

Mohamed T Abuelazm et al. Int Urol Nephrol. 2023 Oct.

Abstract

Background and objective: There is currently no FDA-approved medical therapy for delayed graft function (DGF). Dexmedetomidine (DEX) has multiple reno-protective effects preventing ischemic reperfusion injury, DGF, and acute kidney injury. Therefore, we aimed to evaluate the reno-protective effects of perioperative DEX during renal transplantation.

Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and CENTRAL until June 8th, 2022. We used the risk ratio (RR) for dichotomous outcomes and the mean difference for continuous outcomes; both presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022338898.

Results: We included four RCTs with 339 patients. Pooled risk ratio found no difference between DEX and placebo in reducing DGF (RR: 0.58 with 95% CI [0.34, 1.01], p = 0.05) and acute rejection (RR: 0.88 with 95% CI [0.52, 1.49], p = 0.63). However, DEX improved short-term creatinine on day 1 (MD: - 0.76 with 95% CI [- 1.23, - 0.3], p = 0.001) and day 2 (MD: - 0.28 with 95% CI [- 0.5, - 0.07], p = 0.01); and blood urea nitrogen on day 2 (MD: - 10.16 with 95% CI [- 17.21, - 3.10], p = 0.005) and day 3 (MD: - 6.72 with 95% CI [- 12.85, - 0.58], p = 0.03).

Conclusion: Although there is no difference between DEX and placebo regarding reducing DGF and acute rejection after kidney transplantation, there may be some evidence that it has reno-protective benefits because we found statistically significant improvement in the short-term serum creatinine and blood urea nitrogen levels. More trials are required to investigate the long-term reno-protective effects of DEX.

Keywords: DEX; Dexmedetomidine; Kidney transplantation; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Forest plot of the primary outcomes [A: delayed graft function (DGF), B: acute rejection]. I2 I-squared, CI confidence interval
Fig. 2
Fig. 2
Forest plot of creatinine (mg/dl). I2 I-squared, CI confidence interval
Fig. 3
Fig. 3
Forest plot of urine output (mL/h). I2 I-squared, CI confidence interval
See this image and copyright information in PMC

References

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